Accountable Care

The transformation of health providers into Accountable Care Organizations (ACOs), as called for in the Patient Protection and Affordable Care Act of 2010, has dramatic implications based upon how CMS may assess and pay providers for their services in the future. Clearly, such a development has profound strategic and structural ramifications for providers. Although the move to an accountable care structure is currently at the choice of the Executive Management team and their Boards, there is a strong push from the Federal government to advance this transformation. And, many organizations have already undertaken the changes necessary to take advantage of the incentive payments associated with the impending CMS program.

This transition in the healthcare industry has the intent of bending the cost-quality curve, which will require a multitude of drivers beyond the single concept of ACOs. The “Gray Tabs” on the side bar represent key topic areas which HIMSS will continue to populate and expand in sync with the evolving changes in the industry.

Truly accounting for the outcomes of care and measuring performance to achieve overall quality and efficiencies in the healthcare industry are topics and information. The first of the five goals of meaningful use is to “Improve quality, safety, efficiency and reduce disparities,” all of which will be leveraged through meaningful use of EHRs.

Dr. Berwick has brought the “Triple Aim” to CMS, giving us all the direction to aim for better individual care anchored in the IOM’s [Institute of Medicine “Crossing the Quality Chasm six principles of quality improved impact on population health, and to do so all at a lower per-capita cost.

Secretary Sebelius of the Department of Health and Human Services (HHS), sought public input mid-October 2010 for the development of a National Health Care Quality Strategy and Plan to which HIMSS responded pointing out the key role of health IT. The National Priorities Partnership (NPP) (of which HIMSS is a partner) also responded to HHS, and part of its suggestion was to add two additional goals to its existing six, one of which is “Infrastructure Supports.” This new goal emphasizes the need for health IT to support quality. The eight NPP goals and the five goals of meaningful use are closely aligned. A private/public multi-stakeholder body specifically leveraged by HHS to influence the strategic direction of these projects is the National Quality Forum (NQF), with multiple health IT projects in motion to promote the goal of quality, with HIMSS, as a member of NQF, contributing to these projects.

There are several additional initiatives influencing the impact and value of Health IT on quality. One of which is the one-year study by IOM to examine best policies and practices for improving health care safety with health information technology (through a $1M grant from ONC). Another significant part of the new infrastructure is the CMS Innovation Center, which is leading efforts to test innovative payment and service delivery models to reduce program expenditures while enhancing the quality of care furnished to individuals. The Innovation Center jointly announced with HHS the Partnership for Patients, a public-private partnership to improve patient safety through care coordination, with specific goals of decreasing preventable hospital-acquired conditions by 40% and decreasing hospital readmissions by 20%. Many stakeholders have already joined the Partnership for Patients have publicly signed on to support Partnership for Patients, including HIMSS. Understanding the implications and alignment of the National Quality Strategy, the goals of Partnership for Patients, and the goals and role of the National Priorities Partnership in each, HIMSS and NQF provided an overview/“how to get involved” presentation in April ’11.

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